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A vulvar varicose vein is, as the name suggests, a varicose vein that affects the vulva. It is a particularly dilated vulva vein, like a varicose vein in the thigh for example. There are also pelvic varicose veins, which affect the pelvis area, or perineal varicose veins, affecting the perineum area.
Vulvar varicose veins mainly occur in pregnant women, often during the second trimester of pregnancy. In most cases, these varicose veins on the vulva disappear spontaneously after childbirth or after stopping breastfeeding.
The main cause of a vulvar varicose vein is hormonal : as for varicose veins in the legs, it results from venous insufficiency, except that the veins in the vulva are even more sensitive to hormonal changes.
Vulvar varices: symptoms and diagnosis
Vulvar varicose veins are most often asymptomatic. However, there may be a feeling of swollen vulva, itching, discomfort during sexual intercourse or even when walking.
The diagnosis of a vulvar or perineal varicose vein is based above all on clinical observation, first in a standing position, then lying down. The gynecologist or the midwife will carry out an examination of the area, which will reveal one or more bilateral varicose veins in the vulva, in the form of bluish or purplish dilations, soft, and which disappear under pressure.
As they are often associated with varicose veins on the legs, the practitioner should then systematically search for any varicose veins on the lower limbs and a history of venous insufficiency and thrombosis.
The gynecologist or midwife may subsequently request additional advice from a vascular doctor, and an echo-doppler to refine the diagnosis, especially if vulvar varicose veins are present in the first trimester of pregnancy, outside pregnancy, or if asymmetry is observed.
Note that vulvar varicose veins concern an average of 10% of pregnancies, and seem more frequent in first-time mothers and in women suffering from venous insufficiency, which pregnancy amplifies.
What treatment for a vulvar varicose vein?
If the vulvar varicose vein does not cause particular symptoms, and it is not accompanied by venous insufficiency or risk of thrombosis, treatment is not mandatory.
On the other hand, the pain, discomfort and heaviness due to a vulvar varicose vein during pregnancy can be treated by phlebotonic (or venotonic) drugs. A anti-itch cream (with zinc oxide) can also provide relief to an uncomfortable pregnant woman.
In the presence of venous insufficiency, compression stockings may be prescribed to improve venous return. As with heavy legs, hygiene measures (cold water jet, raising the bed, wearing loose clothing …), as well as the use of alternative medicine (homeopathy, phytotherapy – red vine herbal teas in particular) can be considered as a natural treatment, after consultation with the health professional following the pregnancy.
Note that in the event of pelvic congestion syndrome (pain in the lower abdomen) or if vulvar varicose veins persist beyond one month after pregnancy or the end of breastfeeding, it is advisable to consult a phlebologist / angiologist for specialized care.
Vulvar varicose veins during pregnancy: is cesarean section compulsory?
The presence of vulvar varicose veins does not in itself represent a brake or a contraindication to vaginal delivery. However, if vulvar and pelvic varices are too large and painful, there is a significant risk of varicose bleeding during childbirth. In this case, cesarean section may be preferred to avoid complications.